Ghana Health Service exploits pregnant women - Report

Some women have experienced the pain of losing a baby through miscarriage just when they were getting used to the idea of becoming mothers.

Some have also gone through the entire nine months, been to the hospital to be delivered of a baby but returned home empty-handed because of stillbirth.

Husbands have taken their wives to theatres to be delivered of a baby but returned home without their wife or baby.

For these reasons, women are continuously advised to report for antenatal in the first trimester, which is the first three months of pregnancy to get guidance to live healthy in the nine-month journey to reduce the rate of miscarriages, stillbirths and death of pregnant women.

Mrs Eunice Adjei, a mother of one, went through the ordeal of losing her pregnancy of seven months old. According to her, she felt her baby was fine until she reported to the hospital to report ill.

The result was shocking. The health professionals could neither trace the heartbeat of the foetus nor find it in the womb.

She was, thus, referred to the Legon Hospital for a Cesarean Section. At the hospital she had a crisis. Her stomach churned and dilated.

Minutes later, she effortlessly gave birth to a baby boy she described as handsome. Unfortunately, the baby was dead on arrival. She was distraught for weeks, but was consoled by her husband.

From the above account, losing a baby is indeed no joke. One, therefore, wonders why after all such sad stories and vigorous campaign by the Ghana Health Service (GHS) to convince pregnant women to seek prompt maternal healthcare, many women, especially the poor ones, fail to report early for healthcare.

Kasapa FM’s Francisca Emefa Enchill set out to investigate and find some answers. The result was that there were rots in some health institutions that put impediments in the way of the poor pregnant women who seek healthcare.

Public health centres which are patronised by majority of pregnant women in Ghana were put on the spotlight. They were the Kaneshie Polyclinic, La General Hospital, formerly La Polyclinic, and Amanfrom Health Centre, located near Kasoa in the Central Region. These facilities are patronised by mainly poor women.

Evidence gathering

To be able to gather solid evidence, the reporter had to go through the antenatal process, so the the services of two pregnant women were hired. One of the pregnant women had been in the house for five months without attending antenatal clinic. Her reason? She did not have money to pay for the many bills charged by Amanfrom Health Centre. But according to the GHS, antenatal service is free, so why the bills?

“At five months, I realised my life could be in danger so I tried to gather money on my own since my boyfriend said he did not have money. I managed to gather some small money and then went to the hospital. When I got to the hospital, they kept demanding money, money, money till I run out of the little amount I had on me.”

Findings

During investigations, it came out that all the three health centres focused on were guilty of illegal practices that make accessing healthcare during pregnancy a daunting task to the impoverished.

The health centres were engaged in extortions in the form of charging illegal fees without receipts.

Extortion

Amanfrom Health Centre

At the Amanfrom Health Centre extortion of money from pregnant women was at its best.

On a first visit to the antenatal unit of this health centre, the health centre would issue a maternal health record book, which is a nine-page photocopy of the original red coloured record book stapled together.

Just a handful of patients visiting this health centre are given the original book for GH¢ 6.00, while majority of the pregnant patients are given the photocopies for GH¢ 5.00, the excuse being that the centre had run out of the original book.

After paying for these books, pregnant women go to a health worker who sits at a table to check vitals. After checking the vitals, the pregnant women are asked to drop GH¢ 1.00 into a cardboard box placed on the table without any reason given to them.

“Put GH¢ 1.00 in the box” is all they say to the patients. They are then asked to buy plastic containers to get urine samples for GH¢ 1.00. At least with the Amanfrom Health Centre, washrooms are not paid for.

The patients then go to the consultation room, where they pay another GH¢ 1.00 for the paper stick test kit to be used to run a test on the urine samples.

A blood test on hemoglobin and HIV AIDS is run on each patient using test kits and then they are asked to pay GH¢ 10.00 for those tests.

Kaneshie Polyclinic

At the Kaneshie Polyclinic’s antenatal unit, the first instruction from health workers at the facility is to acquire ‘Maternity Health Record Book’, also known as ‘Folder’ and ‘Card.’

The folder is supposed to be given to pregnant women for free but at the Kaneshie Policlinic, the book is sold at GH¢ 5.00.

The next stage was urine sample to take to the consultation room, and the patients have to pay 50 pesewas for the plastic containers. To visit the washroom, the pregnant women must doll out another 50 pesewas.

Vitals such as height, blood pressure, weight and temperature are checked before seeing a midwife. In there, the urine sample is tested with a paper stick test kit; after the test, the pregnant patient is asked to dish out money again for the test run. The charge is GH¢ 5.00.

La General Hospital

At the General Hospital, otherwise known and called La Polyclinic, there were also instances of extortion.

At the facility, patients are made to pay for folders at a cost of GH¢ 5.00, and buy four different plastic containers for collecting samples at a cost of GH¢ 2.00.

To visit washroom, the pregnant woman is charged 30 pesewas without tissue paper and 50 pesewas with tissue paper.

Aside the above listed costs, all other services at the facility were free as they are supposed to be. The services included checking of vitals, urine test, HIV test and consultation.

receipts

Kaneshie Polyclinic

At the Maternal Health Unit of the Kaneshie Polyclinic, receipts were not given for any of the monies paid at the various sections visited.

When a midwife, fondly called Aunty Serwaa by her colleagues, was asked for receipts for monies paid, she blatantly responded that they don’t give receipts there. “Oooh, we don’t issue receipts here ooo,” she retorted.

At the laboratory, the test cost GH¢ 30.00, but no receipt was issued.

The GH¢ 30.00 was paid directly to the laboratory technician who had a cardboard box on his desk into which he dropped the money and gave the patient no receipt.

Amanfrom Health Centre

At the Amanfrom Health Centre, no receipt was issued for all the payments made. They included payments for folder, vitals, urine test, container and hemoglobin tests.

La General Hospital

Although the La General Hospital was also charging a few illegal fees, the health workers issued receipt for the GH¢ 5.00 charged for the record book, but gave no receipt for the other services.

Reactions

Kaneshie Polyclinic

Dr Patrick Amo Mensah, Medical Director at the Kaneshie Polyclinic, when asked about the bad practices at the facility he heads, said he did not know about those practices captured on tape.

He pledged to independently investigate and apply appropriate sanctions, where necessary, to the individuals involved.

According to him, the authorities of the hospital have made efforts to clear the system of such bad practices, hence he will take steps to establish the fact and punish the offenders.

Amanfrom Health Centre

In a telephone interview with the Medical Director of Amanfrom Health Centre, Dr Akos Ayisi, she insisted that the facility did engage in such activities.

She said even if there was evidence of illegal charges at the facility, a few individuals would have been responsible and not an official norm at the centre.

La General Hospital

In an interview with Atindaana Nsobilla, the Administrator of La General Hospital, he admitted knowing about the sale of record books to pregnant women but explained that it was because there was shortage of folders in the region last year, hence the regional directorate managed to get the hospital some folders at a cost and asked them to give the folders out to patients at a cost.

He added that in the latter part of September, their stores were filled with a stock of new folders which were given to the hospital for free; hence he did not expect pregnant women to pay for folders any more.

Concerning health workers selling folders to pregnant women even after acquiring new stock for free, he said they might have probably been selling old stock to patients.

Mr Nsobilla further noted that maternal health care is a service which is supposed to be free as all medical bills which are not even free are covered by the National Health Scheme (NHIS).

Ghana Health Service

Mr Kwabena Adu Adjei, Head of Procurement at the GHS, responding to the findings of the investigations, disclosed that the GHS had distributed over 300,000 copies of the maternity record book and the copies were in abundance in the system.

He said the book and other basic items used in providing maternal health care are given to the hospital for free by the GHS and patients are to get those items for free.

He added that pregnant women are practically supposed to go through the entire process for free, confirming Mr Nsobilla’s statement that even the few things that attract charges are covered by the NHIS.

“They are supposed to be given to the pregnant women for free; they are not supposed to be sold, so anywhere you find people selling them, let us know because they are not to be sold.”

He urged Ghanaians to report to the district health directorate any health centre found selling folders so that they could take action.

“They are not to be sold; it’s a free maternal health record book. As I said, we had the support from the United Kingdom Department for International Development to print those books for free so they are not supposed to be sold.”

With respect to Amanfrom Health Centre using photocopied books, Mr Adjei expressed surprise at the practice in that health facility as according to him they have the books in excess at the Central Stores.

He said health facilities found culpable should be reported to their regional directorate for appropriate action to be taken.

“They are not supposed to use photocopied folders; there are enough in the system now so if you know anybody who is doing that, they should contact the regional directorate,” he added.

Observations:

Aside exploiting pregnant women, the health workers were calm, respectful and in a friendly manner administered healthcare to pregnant women.

Despite having agencies or representatives of banks stationed in all these health centres, the only test that patients pay for at the bank is the scan; all other payments are done on table top to health workers.

It was realised that pregnant women who sought maternal healthcare were taken care of by only nurses and midwives as they did not get the opportunity to meet a gynecologists throughout the nine-month period.

Concerning the illegal monies charged, pregnant women felt scared to ask questions about what they were paying for due to the intimidating environment.